Healthcare Provider Details

I. General information

NPI: 1538378013
Provider Name (Legal Business Name): DR. WEISE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 DATURA ST STE 414
WEST PALM BEACH FL
33401-5632
US

IV. Provider business mailing address

PO BOX 8085
WEST PALM BEACH FL
33407-0085
US

V. Phone/Fax

Practice location:
  • Phone: 561-707-6311
  • Fax:
Mailing address:
  • Phone: 561-845-5524
  • Fax: 561-845-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY0003680
License Number StateFL

VIII. Authorized Official

Name: DR. DENNIS MILTON WEISE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 561-707-6311